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Fever alone no cause for fear

The Baltimore Sun

Many parents worry too much about the danger of childhood fevers and tend to overtreat even the mildest temperatures, according to research unveiled yesterday by Johns Hopkins doctors. A little fever, they say, may actually be good for kids.

The findings confirm what pediatricians have heard from panicked parents over the years - especially those who call because their child has a temperature of 99 degrees (it's not technically a fever until it hits 100.4 degrees, doctors say). Often, they report that they've given more medication than necessary for higher temperatures.

"Parents have this idea we've got to get fever down at all costs," said Dr. Michael Crocetti, a pediatrician at Johns Hopkins Bayview Medical Center and an author of the study. "Fever actually helps, for most infections, to fight the infection. It helps our immune system work better."

The Johns Hopkins Children's Center study, presented yesterday at the annual meeting of the Pediatric Academic Societies in Honolulu, was drawn from 487 interviews with parents of patients at two Baltimore clinics. Researchers found that parents gave their children acetaminophen and ibuprofen more often than recommended - and that some parents develop severe "fever phobia," a fear that fever will cause brain damage and death.

"Parents for some reason have gotten the message that fever is dangerous and haven't gotten the counter side, which is fever fights off infection," said Dr. Virginia Keane, a pediatrician at the University of Maryland Medical Center. "Most of the viruses that infect us can't live at temperatures higher than 101 degrees. If you're not uncomfortable, it's good to have a fever."

Only fevers above 107 degrees can cause brain damage in children, Crocetti and others said. Those temperatures are rare and not typically the result of infection. Instead, they're usually brought on by heat stroke or hyperthermia, a condition caused, for example, when a child is left too long in a locked car.

In most cases, the doctors said, fever is simply a symptom of an underlying infection - say, chickenpox or flu - that the fever is fighting.

The study compared how parents of different ethnic groups view fever. It found that black and Hispanic parents were more likely to describe themselves as "very worried" about fever than white parents.

Still, 80 percent of the parents said they had roused a sleeping child to give fever medication, even when the child was resting comfortably. Doctors say this is not necessary.

Parents of all ethnicities had trouble recognizing the range of normal temperature - 97 to 100.3 degrees - though Hispanic parents were the least likely to view those temperatures as normal. That doesn't surprise Keane.

"People think 99 is a fever and it's not," she said. "Most kids can tolerate 102 with a big glass of ice water."

Crocetti said parents were all over the chart in pinpointing a fever - some guessing as high as 108 degrees or even 120, while another said 90 degrees, with the rationale that "when it's 90, it's hot outside."

Many parents learn about treating fever from their mothers and grandmothers, not from medical professionals, doctors say. Putting a child in a cold bath, for example, might actually drive up the fever. Alcohol baths can be harmful, too, because some of the alcohol can be absorbed through the skin of younger children and sedate them.

Many doctors say parent re-education is the right prescription.

"It's a long tradition. It's hard to overcome it and say, 'You don't really have to treat the fever too aggressively,'" said Dr. Robert J. Ancona, head of pediatrics at St. Joseph Medical Center in Towson. "Treating fevers under 101 [degrees] - which many people do - is pretty much out of the question. Fever is not an emergency."

The exception arises in newborns. Doctors worry when babies younger than 3 months develop fevers because they have immature immune systems and are not as well equipped to fight infection. An elevated temperature could be the only sign of a serious infection, whereas older babies tend to have other symptoms, too.

When a young baby has a fever over 100.3 degrees - a relatively uncommon occurrence - a doctor should be called.

Doctors urge parents to treat the symptoms, not the number on the thermometer. If a child has a 102-degree temperature and is running around and acting playful, treatment may not be necessary. If that child isn't feeling well, go ahead and give Tylenol or Motrin, just don't exceed the dose on the package, doctors say.

That's how Nan Walker, an Arnold mother, approaches fevers with her son Hadlee, 6. "As soon as you catch it, you just keep an eye on it," she said. "If he's still physically active, I'm OK with it."

Only when he starts feeling flushed and uncomfortable does she break out the Tylenol.

UM's Keane said she worries that marketing by drugmakers sends parents to the medicine cabinet too quickly. A particular gripe: a television commercial showing a mother feeling a warm forehead and saying, "You call the doctor, I'll get the Tylenol."

She complains that mothers give more fever medication than they should - even exceeding the rule of five doses in 24 hours.

There are long-standing questions about treating a fever with medication at all. Some doctors believe it can prolong the underlying infection.

Keane cited a study conducted 20 years ago by Dr. Timothy Doran, now head of pediatrics at Greater Baltimore Medical Center in Towson. Doran and his colleagues examined the duration of chickenpox with and without acetaminophen.

"If you didn't give any fever medicine," Keane said, "your chickenpox went away sooner."

Treating your child's fever

Remember that normal temperature ranges from 99 degrees to 100.3 degrees.

Treat the behavior, not the number on the thermometer. If the child's temperature is above 102 but he feels fine, wait it out. If he doesn't feel well, give medication.

Symptoms more worrisome than fever alone include dehydration (fewer than three wet diapers in 24 hours), fever lasting more than five days and a baby who doesn't wake up to feed.

Acetaminophen should only be given every four to six hours, with no more than five doses in 24 hours.

Never give aspirin to a child.

[ Source: Johns Hopkins Medicine]

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